As Ebola continues to play global hopscotch, Asian countries are seeking to make good on the advanced notice that the deadly virus could turn up anywhere, anytime.
At issue in Asia — and everywhere — is not just that medical scaffolding varies across and within nations, with some lacking robust medical facilities, but that even sophisticated cities boasting top-notch hospitals are foundering. The infections of two health care workers in Dallas, as well as a nurse in Madrid, have illustrated that even highly developed nations are not immune.
“Perceived preparedness and actual preparedness are not the same thing,” says Stephen Morse, professor of epidemiology at the Columbia University Medical Center.
“We thought the U.S. would be well prepared, but certainly our first case [in Dallas] was not a good model for replication, and I don’t think Spain did too well either,” explains Morse. “But that’s what happens when you haven’t seen this before. You don’t know what to do.”
Still, Asia has some advantages as it readies itself for Ebola. Flight patterns suggest that the influx of travelers from Ebola-stricken West African countries to the Asian continent is far less than it is to Africa, Europe or North America.
Asian nations also have an edge in that they have been through epidemics before: SARS tore through the West Pacific in 2003, killing almost 800 people worldwide, mostly in Hong Kong and mainland China. Avian flu also pummeled this area around the same time, and outbreaks of virulent influenza strains perennially menace the region.
“The most likely scenario, if we have an imported case of Ebola, is that there will be some risk of having secondary cases, but I don’t think we will have a big outbreak at this point in time,” says Hitoshi Oshitani, professor of virology at Tohoku University Graduate School of Medicine in Sendai, Japan.
In part, that’s because Ebola is much more straightforward to contain than the airborne SARS — spread through coughing and sneezing — if procedures are followed rigorously, says Oshitani, who from 1999 to 2005 was the regional adviser for communicable-disease surveillance and response at the WHO’s Western Pacific Regional Office during the SARS and avian-flu outbreaks. When SARS first appeared “we didn’t know what to do at first,” he says.
But having weathered these outbreaks now makes Asian nations stronger. “After SARS and Avian flu, Asian countries have invested quite a lot in infectious disease control,” says Oshitani. “Before 2003, many countries in Asia had very limited capacity, and today they have much more capacity.”
That said, much depends on where across Asia’s socioeconomic smorgasbord a hypothetical Ebola case makes landfall.
For example, Hong Kong, blistered by the memory of SARS, has made significant preparations, says Malik Peiris, director of the School of Public Health at the University of Hong Kong. “Infectious diseases, especially diseases coming from the outside, have been a constant threat to Hong Kong and have kept people on their toes,” he says.
Hong Kong, which had just “a handful” of isolation beds in 2003, now has about 1,400, plus a designated infectious disease hospital, says Peiris. At that hospital, he adds, the facilities are “more than adequate to deal with SARS and certainly more than adequate to deal with Ebola.”
Preparing for Ebola is also foremost on health officials’ agendas in mainland China, Peiris says, while noting that health care is uneven across the world’s most populous nation, with world-class hospitals in major cities but spotty health care in rural areas. Dense populations and an incubation period of up to 21 days make Ebola potentially extremely problematic.
Chinese officials told state media in August that security at the airport in China’s southern Guangdong province, which does roaring business with African traders, had been bolstered.
India also presents a problem. Peter Piot, director of the London School of Hygiene and Tropical Medicine who co-discovered Ebola, told the Guardian earlier this month that Ebola outbreaks in Europe or North America could quickly be brought under control. However, “I am more worried about the many people from India who work in trade or industry in West Africa,” he said.
Indian Health Minister Harsh Vardhan told Parliament in August that some 4,700 Indians are working in Guinea, Liberia and Sierra Leone. India is using thermal scanners at its airports similar to those used at Nigeria, which was declared Ebola-free earlier this month. The country has also designated hospitals for handling the virus, and has also held preparedness drills, though a paltry ratio of 0.07 hospital beds per person does not bode well for any significant outbreak.
“The big problem is in high-density populations with low health coverage,” says Peiris. “In Mumbai, you have areas of quite significant poverty, and if Ebola enters such a situation, you could have a problem on your hands. Major cities really need to be prepared.”
The Philippines, boasting an estimated 1,700 nationals working in West Africa, is also bolstering readiness. Lyndon Lee Suy, spokesman at the Philippines Department of Health, says that three hospitals are designated to handle any Ebola cases, plus a training workshop is being run at 19 government hospitals, about 50 private hospitals and numerous local government clinics. All hospitals in the Philippines, which battled SARS in 2003 and H1N1 in 2009, have isolation rooms, he says.
“No country can ever rate how prepared it is for something like this,” says Lee Suy. “But the health system here is not the same as the one in West Africa. We are in a better position.”
Even Asian countries that have no direct flights to West Africa, and have limited ties to the region, are wary of being caught off guard.
Krishna Kumar, president of the Malaysian Medical Association, says his country was jolted by the Nipah virus in 1999, which killed more than 100 people nationwide, and has learned “hard but important lessons.”
“We weren’t expecting it,” he says. “It woke us up.”
Krishna says public alarm is low in Malaysia, but health officials are yet mindful “anything could happen.” All airports have thermal checks, and 28 government hospitals have isolation rooms and are fully equipped with protective gear.
“We have the systems in place,” he says, “but to know how ready you are — well, it’s only when something happens, then you know if you were ready.”